Standard Operating Procedures Enhance TB Case Detection in Ethiopia

The USAID-funded TB CARE I project, led by KNCV Tuberculosis Foundation (KNCV) in partnership with Management Sciences for Health (MSH), is conducting a pilot study in 28 health facilities in Ethiopia to roll out standard operating procedures (SOPs) for improved tuberculosis (TB) diagnosis, treatment, and care.

The SOPs include instructions for TB screening, irrespective of the patient’s presenting illness or chief complaint. The guidelines instruct staff members to ask every patient, “Have you had cough for more than two weeks?” If the patient answers, “yes,” he or she is immediately tested for TB.

In addition to screening guidelines, the SOPs include concise, bulleted instructions, tailored to each of the facilities’ service delivery areas. To help health workers access these guidelines and use them more readily, TB CARE created seven posters of the different SOPs to be displayed in laboratories and waiting and consultation rooms.

Twenty-eight facilities received the posters and staff are now using them as a quick reference for clinical guidance and protocol instructions.

TB CARE worked with multi-disciplinary teams at each of the 28 facilities to monitor implementation of the SOPs. These teams discuss implementation of the new SOPs and brainstorm solutions for challenges encountered in this roll-out project. For example, if a service provider is not screening every patient for TB symptoms, the team develops a plan to address the noncompliance through a constructive discussion with the provider and follow-up supervision.

By strictly adhering to these SOPs, the 28 facilities increased the number of TB cases identified from 50 per quarter before the intervention to an average case detection rate of 73 per quarter in the year following the intervention. Encouraged by these positive outcomes, clinicians are continuing to adhere to the SOPs.

TB CARE I Ethiopia will evaluate this intervention in preparation for nationwide roll-out of the SOPs. If the evaluation continues to show strong results, the regional health officers will work with Ethiopia’s Ministry of Health and other partners to expand the SOP intervention nationwide.